<!DOCTYPE html>
<html>
<head>

<title>
Personal Info
</title>

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<meta charset="utf-8">
<meta name="generator" content="Wufoo.com" />

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<link rel="stylesheet" href="../css/structure.css" type="text/css" />
<link rel="stylesheet" href="../css/form.css" type="text/css" />

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 <script type="text/javascript">
// this fixes an issue with the old method, ambiguous values
// with this test document.cookie.indexOf( name + "=" );
function Get_Cookie( check_name ) {
	// first we'll split this cookie up into name/value pairs
	// note: document.cookie only returns name=value, not the other components
	
	var a_all_cookies = document.cookie.split( ';' );
	var a_temp_cookie = '';
	var cookie_name = '';
	var cookie_value = '';
	var b_cookie_found = false; // set boolean t/f default f
	//alert ("b_cookie_found" + b_cookie_found);
	//alert ("a_all_cookies.length" + a_all_cookies.length);
	
	for ( i = 0; i < a_all_cookies.length; i++ )
	{
		//alert ("a_all_cookies.length" + a_all_cookies.length);
		// now we'll split apart each name=value pair
		a_temp_cookie = a_all_cookies[i].split( '=' );
		//alert("a_temp_cookie " + a_temp_cookie);
		//alert("a_all_cookies[i]" + a_all_cookies[i]);
		// and trim left/right whitespace while we're at it
		cookie_name = a_temp_cookie[0].replace(/^\s+|\s+$/g, '');

		// if the extracted name matches passed check_name
		if ( cookie_name == check_name )
		{
			b_cookie_found = true;
			// we need to handle case where cookie has no value but exists (no = sign, that is):
			if ( a_temp_cookie.length > 1 )
			{
				cookie_value = unescape( a_temp_cookie[1].replace(/^\s+|\s+$/g, '') );
			}
			// note that in cases where cookie is initialized but no value, null is returned
			document.write('<p> ');
			document.write(cookie_value);
			document.write('</p> ');
			return cookie_value;
			break;
		}
		a_temp_cookie = null;
		cookie_name = '';
	}
	if ( !b_cookie_found )
	{
		return null;
	}
}

</script>
</head>

<body id="public">
<div id="container">


<!--<form action = "/UserPersonalInfoServlet" id="form125" class="wufoo topLabel page" autocomplete="off" enctype="multipart/form-data" method="post" action="#public" novalidate> -->
<form action="/UserPersonalInfoServlet" method="post" id="form125">
<header id="header" class="info">
	<h2>Add personal information to database</h2>
	<div></div>
</header>

<ul>
		
<li id="foli102" 		class="     ">
	<label class="desc" id="title102" for="Field102">
		Username:
			</label>
	<span>
	<script type="text/javascript" >
	
	var username = Get_Cookie('passUsername');
	</script>
		<!-- <input id="Field102" 			name="Userid" 		value=""	type="text" 			class="field text fn" 			value="" 			size="8" 			tabindex="1" 									/> -->
		<!--<label for="Field102">First</label>-->
		<label id="Field102" 			title=username></label>	 
	</span>

	</li>

<li id="foli104" 		class="     ">
	<label class="desc" id="title104" for="Field104">
		First Name:
			</label>
	<div>
		<input id="Field104" 			name="firstName" 			type="text" 			spellcheck="false" 			class="field text medium" 			value="" 			maxlength="255" 			tabindex="3" 									/> 
	</div>
	</li>

<li id="foli104" 		class="     ">
	<label class="desc" id="title104" for="Field104">
		Last Name:
			</label>
	<div>
		<input id="Field104" 			name="lastName" 			type="text" 			spellcheck="false" 			class="field text medium" 			value="" 			maxlength="255" 			tabindex="3" 									/> 
	</div>
	</li>

<li id="foli105" 		class="     ">
		Sex:
	<div>
		<select name="gender">
			<option value="Male">Male</option>
			<option value="Female">Female</option>
		</select>	
	</div>
</li>

<li id="foli105" 		class="     ">
	<label class="desc" id="title105" for="Field105">
		Year of Birth
			</label>
	<div>
		<select name="yearBorn">
			<option value="1975">1975</option>
			<option value="1976">1976</option>
			<option value="1977">1977</option>
			<option value="1978">1978</option>
			<option value="1979">1979</option>
			<option value="1980">1980</option>
			<option value="1981">1981</option>
			<option value="1982">1982</option>
			<option value="1983">1983</option>
			<option value="1984">1984</option>
			<option value="1985">1985</option>
			<option value="1986">1986</option>
			<option value="1987">1987</option>
			<option value="1988">1988</option>
			<option value="1989">1989</option>
			<option value="1990">1990</option>
			<option value="1991">1991</option>	
			<option value="1992">1992</option>
			<option value="1993">1993</option>
			<option value="1994">1994</option>
			<option value="1995">1995</option>
		</select>	
	</div>
	</li>	

	
<li id="foli105" 		class="     ">
	<label class="desc" id="title105" for="Field105">
		Country of citizenship
			</label>
	<div>
		<input id="Field105" 			name="citizenship" 			type="text" 			class="field text medium" 			value="" 						maxlength="255" 						tabindex="4" 			onkeyup="" 									/>
	</div>
</li>		

</ul>
	<input type="submit" style="position: absolute; left: -9999px; width: 1px; height: 1px;"/>
</form>

</div><!--container-->




</body>
</html>